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DEC. 2. 2003 2:54PM rAUOR EARTH TECH N0: 1619 P. 1 <br /> �d SA.N JOAQUIN COUNTY EHO LOG NUMEIEqq : <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 E WeberAve 3` Icor Stockton, C##95205 E 1: . - :::-' �.� r" . I-1EAL.111 <br /> �, �::: <br /> (209)468-3420 Fax: (209)464-0138 Web: www. -co-sanjoaquin.mus/ehd <br /> PUBLIC RECORDS RELEASE APPLICATION03 DEC —2 Phi 3: 42 <br /> APPUCMr:—EP-LL 4n f, c-A LF—Z BusINFSSIAGENCY: b01� erg�I -7C41 OL , <br /> ADDRESS: <br /> PHON � P C l 1 FACSIMII..J : Q <br /> TENTATIVE*APPOINTMENT DATE: E? {�2r p Time: <br /> (Please allow 10 business days from date of application submitlat) <br /> CHECK BOX To EXPEDrM REQUEST-393.00 M8=IWQUEST PROCESSED IN 3 BUSENESS HAYS <br /> SIGNATURE OF APPLICANT DATE . �3 <br /> Department Use Only <br /> FILE ADDREss UNfr <br /> s>� a r,5 <br /> 2- L,9 46 0 M 1-r a 3 Yh ❑ Un' 1 <br /> 5. sr" G r �� <br /> A. s k97� 6 . A-) nit 2 <br /> co <br /> a. sv � /4U S v G 3506 m nit ff <br /> 9. Street a1;J © 5 <br /> �a. soca <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) C3 HOUSIKG ABATEMENT' SOLID WAS'T'E FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) _- ❑ FOOD FACILITY SOUD WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) Q DOG KENNEL 12 DAIRY i <br /> HAZARDOUS WASTE GENERATOR 0 CHICKEN RANCH 171 PKG TREATMENT PLANT <br /> i'nERE:n PERflairmo FAGiLiTY 13 MOTELTHOTEL ❑ PUMPER TRUCKIYARDICHE"M TOILETS <br /> TATTOOIBODY PIERCING ❑ POOLISPA E3 LAND USE APPLICATION SITES <br /> MEbICAL wAz7E FACury ❑ OTHER(PLI:ASfr SPEGFY} <br /> I. list up to ten addresses In the space above. Select the type'(s)of flea from the fist above by checking <br /> the appropriate box(es). At least one file type MUST be selected. Fax to 209146"138 or mail to the <br /> address indicated above. <br /> 2. EHD will notify the applicant if any EHD files exist. An appointment for review will be confirmed <br /> approximately five business days but no later than ten (10) days after receipt of application. The files <br /> will be held for a maximum of five business days for review. Appointments should he scheduled <br /> accordingly. <br /> 3. A file that is actively being worked on by EHD staff may not be immediately available for review. A new <br /> application may be submitted when the file Is available. <br /> 4. Any file not retumed in the same condition as released will be reorganized by EHD staff at the expense <br /> of the applicant. Future file reviews by the same applicant may require a$93.04 deposit prior to-review. <br /> S. "TENTATIVE appointment dates must be confirmed with EHD staff.- - <br /> 6. Applications received after3:00 pm will be processed the next business day. <br /> CONFIRMED APPOINTMENT DATE TIMI= <br /> DATE CONFIRMED � � -PHONE . FAX ,- INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> cm 4E 02 COfi <br /> t 3-C- P <n 4L-,j f dox <br />